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GENERAL EVENT FILE INFORMATION <br />Name of Event:1. <br />2. <br />3. <br />601-24. <br />5. <br />406.Average Age: <br />UTILITIES <br />No1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />TEMP EVENT APP <br />I understand that as a tei <br />standards and the Environmental' <br />EHD 16-02 <br />11/4/14 <br />I Number of dumpsters: <br />Method of disposal of liquid waste for food booths: rS C 'tVx.O'V <br /> Yes <br /> Yes JzfNo <br />/□'Yes No <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />b) Application Review Fee of <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />;ary event coordinator, I am responsible for meeting California State <br />•alth Department policies and procedures. <br />£ f orerx y >; \\rDate; 3/ 31 /1 <br />Page 1 of 11 <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: <br />1 7 2018 <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection and travel time: <br />• $43^"per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times (Sjf^per hour) <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event. <br />w San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-623 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd)... <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />______________________________ <br />X" OOQ^Ime of Event: OOH - QXV\ <br />TrV. oaqjqjt -yY\e. _____ <br />V-Y^C-ftXCT^i-^elep^one^ <br />C < O <br />Date(s) of Event: ^(2-0 <br />Location: <br />Event Coordinator (Name): <br />Mailing Address: <br />Number of Food Booths: I "2- <br />Approximate attendance at peak time: Total Attendance: